To be sleep-deprived and overworked is nearly a badge of honor in some medical circles but others argue that fatigue causes medical errors. While the discussion around the effects of fatigue on doctors continues, a study from London suggests that those who work in teams have a better chance at battling the effects of fatigue than tired people working individually.
The fatigue study by Daniel Frings, PhD, senior social psychology lecturer at London South Bank University, examined the problem-solving skills of 171 army officer cadets during a weekend of training exercises. The series of mathematical tasks the cadets had to solve – individually and in teams – measured cognitive flexibility and explored whether or not team membership could offset impairments caused by fatigue.
The study, published online in the American Psychological Association’s Journal of Experimental Psychology: Applied, examined fatigue resulting from sleep loss. Sleep loss has been found to result in lower cognitive flexibility – poor quality decision making and situational awareness – that, in the medical world, can lead to medical errors. “. . . flexible thinking during problem solving is vital in a variety of contexts, and an overreliance on existing assumptions can be hazardous in any situations where problem environments are changeable,” the study noted.
“Previous research has shown that tiredness is often the cause of errors among medical staff,” said Frings. “My research suggests that one possible reason for this is that, when fatigued, people have less cognitive flexibility. For instance, our participants relied more on previously identified solutions, and failed to spot much better ways of solving the problems in front of them. This can occur after just a couple of nights of shortened or broken sleep.”
Fatigue did not affect how many problems were solved, but did affect the quality of the solutions reached. “In applied settings this is an important distinction: The ‘best’ solution is preferable to the last/most common solution used, and in contexts where decisions have long term ramifications, failing to identify better alternatives can be costly,” Frings noted in the study.
Results from the study showed that individuals who were tired did not perform as well on the tests as those individuals did who were alert. Teams, though, performed just as well tired as when alert.
“The good news is that being on a team which is working together seems to offset (fatigue-induced cognitive inflexibility), at least amongst people who are moderately fatigued,” Frings said. “We do need to see what happens as fatigue becomes more acute, but the take home message is, if you are fatigued you may need to consult with team members more than usual. If no one is available ask yourself: ‘Am I missing something, or making assumptions I shouldn’t, because I’m tired?’.”
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